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Chronic Myeloid Leukemia (CML) - Coggle Diagram
Chronic Myeloid Leukemia (CML)
Epidemiology
Prevalence
More common in adults
Rare in children
Demographics
Median age at diagnosis: 50-60 years
Slight male predominance
Pathophysiology
Genetic Abnormality
Philadelphia chromosome (translocation between chromosomes 9 and 22)
BCR-ABL1 fusion gene: leads to increased tyrosine kinase activity
Cellular Effects
Uncontrolled growth of myeloid cells
Accumulation of these cells in the bone marrow, blood, and other organs
Disease Phases
Chronic phase
Accelerated phase
Blast crisis
Clinical Presentation
Symptoms
Fatigue
Weight loss
Splenomegaly (enlarged spleen)
Signs
Signs
Petechiae
Fullness in left upper quadrant due to splenomegaly
Complications
Anemia
Infection
Bleeding
Diagnosis
Laboratory Tests
Complete blood count (CBC): Elevated white blood cells
Peripheral blood smear: Presence of immature myeloid cells
Molecular Testing
BCR-ABL1 gene detection by PCR
Cytogenetics: Presence of Philadelphia chromosome
Bone Marrow Biopsy
Hypercellularity
Confirmation of increased myeloid precursors
Confirmation of increased myeloid precursors
First-Line Therapy
Tyrosine kinase inhibitors (TKIs): Imatinib, dasatinib, nilotinib
Second-Line Therapy
Alternative TKIs if resistance or intolerance to first-line
Allogeneic stem cell transplantation in specific cases
Supportive Care
Management of anemia and thrombocytopenia
Treatment of infections
Prognosis and Follow-up
Prognostic Factors
Sokal score: Based on age, spleen size, platelet count, and blast cells in blood
Response to treatment
Monitoring
Regular PCR to monitor BCR-ABL1 levels
Regular CBCs and clinical assessments
Long-Term Considerations
Chronic management with TKIs
Potential progression to accelerated phase or blast crisis